Provider Demographics
NPI:1366592834
Name:FOY, CHARLES BRADLEY JR (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRADLEY
Last Name:FOY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9743
Mailing Address - Country:US
Mailing Address - Phone:985-845-8042
Mailing Address - Fax:
Practice Address - Street 1:400 PINE ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9743
Practice Address - Country:US
Practice Address - Phone:985-845-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA39561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice